Payments vary greatly for new veterans with mental illness

Veterans coming home from the wars in Iraq and Afghanistan with debilitating mental ailments are discovering that their disability payments from the government vary widely depending on where they live, an exclusive McClatchy analysis has found.

WASHINGTON — Veterans coming home from the wars in Iraq and Afghanistan with debilitating mental ailments are discovering that their disability payments from the government vary widely depending on where they live, an exclusive McClatchy analysis has found.

As a result, many of the recent veterans who're getting monthly payments for post-traumatic stress disorder from the Department of Veterans Affairs could lose tens or even hundreds of thousands of dollars in benefits over their lifetimes.

The Bush administration has sought to reassure soldiers that they'll be treated fairly, but veterans in some parts of the country are far more likely to be well compensated than their compatriots elsewhere are, the analysis found.

McClatchy's analysis is based on 3 million disability compensation-claims records obtained under the Freedom of Information Act, as well as separate documents that the VA provided. The analysis is the first to examine the issue of state-to-state variations in compensation for those young veterans who've left the military since the war in Afghanistan began in 2001.

For veterans, their families and their advocates, the issue of disability compensation is hugely important. Disability checks are now worth up to $2,527 a month for a single veteran with no children. Because they last a lifetime, low payments set now — when veterans are young — have a dramatic impact.

So far, more than 43,000 recent veterans are on the disability compensation rolls for a range of mental conditions from post-traumatic stress disorder to depression and anxiety. Of those, more than 31,000 have PTSD, which has emerged as one of the signature injuries from the war on terrorism. Given the number of soldiers who've served in Iraq and Afghanistan, that's a fraction of what the total will be.

The VA's assessments of those injuries, however, are all over the map.

Of the recent veterans processed by the VA office in Albuquerque, N.M., 56 percent have high ratings for PTSD. Of those handled by the office in Fort Harrison, Mont., only 18 percent do, the McClatchy analysis found.

"There's no reason in the world that a veteran from Ohio should be shortchanged on benefits simply because he is from Ohio," said U.S. Rep. Zack Space, a Democrat from Ohio, where veterans had among the lowest compensation rates in the nation. "And there's no reason a veteran from New Mexico should be getting more benefits simply because he lives in New Mexico."

A VA benefits official, Michael Walcoff, said the VA was working to minimize unwarranted variations across the country. Judging a condition such as PTSD, however, can be difficult.

"This has been an issue we have been concerned about for a while," he said. "We are trying to learn what we can do to minimize the variances."

So far, 1.5 million Americans have served in the global war on terrorism, and half of them have left active service and transitioned to veteran status, VA documents show.

Those discharged veterans alone already have produced more than 180,000 disability cases, in which veterans are found to have mental or physical ailments linked to their military service. Most already are receiving monthly compensation checks.

Among all the ailments that Iraq and Afghanistan veterans now have, PTSD ranks fourth, behind ringing in the ear, back strain and hearing loss. But because it tends to be far more debilitating than those other conditions — and generates far higher payments — PTSD is the most important disability to emerge from the recent wars.

After years of grumbling by some veterans that they were getting shortchanged, the regional discrepancies became a hot political issue in 2004, after reports by Knight Ridder Newspapers (which McClatchy acquired last year) and others highlighted wide state-to-state swings in the numbers of veterans on compensation rolls and the amounts of their payments.

Under prodding from Congress, the VA said it would work to make its decisions more uniform among the more than 50 regional offices that process disability claims.

This summer, a new report commissioned by the VA again detailed wide variations in disability payments from state to state. But the VA told Congress that doesn't mean that America's newest veterans are being shortchanged.

"It is important to understand that the average payments being compared in the (newest) study cover all veterans currently receiving VA disability-compensation benefits, and that the decisions that awarded these benefits have been made over a period of more than 50 years," a top VA benefits official, Ronald Aument, said in his prepared testimony to a congressional committee. "The average payment for compensation recipients is therefore not necessarily reflective of the experience of veterans currently applying for disability compensation benefits."

Aument went on to tell the committee that things were looking better. "You should see a narrowing band of variation on the new work coming into the system," he said.

The McClatchy analysis found that a recent veteran with PTSD on the rolls in Albuquerque is likely to have a higher payment than a new veteran with PTSD on the rolls in the Montana office.

The VA workers who decide PTSD cases determine whether a veteran's ability to function at work is limited a little, a lot or somewhere in between. They examine the frequency of panic attacks and the level of memory loss. The process is subjective, and veterans are placed on a scale that gives them scores — or "ratings" — of zero, 10, 30, 50, 70 or 100.

McClatchy's analysis found that some regional offices are far more likely to give veterans scores of 50 or 70 while others are far more likely to stick with scores of 10 or 30.

Consider the New Mexico and Montana offices, where there are big differences up and down the scale.

In Montana, more than three-quarters of veterans have ratings of zero, 10 or 30. In New Mexico, a majority of the veterans have ratings of 50 or 70.

On top of that, 6 percent of New Mexico veterans had the highest rating possible — 100, worth $2,527 a month — compared with just 1 percent of Montana veterans.

Because payments are loaded toward the highest end of the scale — the difference between the highest rating and the next highest rating is more than $1,000 a month — the huge gap in ratings has a significant impact on how much the VA is paying, on average, to veterans in different states.

Factoring in all mental and physical disabilities, the average payment for recent veterans ranges from a high of $734 a month in the Little Rock, Ark., office to a low of $435 a month in Honolulu.

Although they're supposed to follow the same rules, the reality for VA workers in different offices is far different. What generates a high rating in one location may produce a lower one somewhere else.

"Frankly, it's difficult," the VA's Walcoff said. "There is some subjectivity. It's not as simple as a below-the-knee amputation."

Part of that is due to training differences around the country, and part is due to the personalities of individual employees who are handling claims and the different doctors and psychiatrists examining veterans who've applied for compensation.

One VA-commissioned study found that local offices often develop their own training material, and that a "major influence" on how people handle cases is the on-the-job training they received from their superiors.

That study said that "rating decisions often call for subjective judgments," and "there have been insufficient efforts at the national level to promote consistency across" regional offices.

"It's generational, but it doesn't end with the old generation," said Space, the Ohio congressman. "Those who routinely and typically undervalue claims teach the new claims evaluators coming in — and they are going to be teaching those same mistakes."

The VA said it was working to train its employees to handle all cases better, particularly those involving PTSD; all workers will undergo PTSD training next year.